Dissemination and Implementation of Function Focused Care for Assisted Living

传播和实施以功能为中心的辅助生活护理

• 批准号: 9519434
• 负责人: BARBARA RESNICK
• 金额: $ 14.94万
• 依托单位: UNIVERSITY OF MARYLAND BALTIMORE
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-09-01 至 2021-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9519434
• 关键词: Activities of Daily Living; Acute; Adoption; Adverse event; Assisted Living Facilities; Belief; Care given by nurses; Caregivers; Caring; Cognitive; Data; Decubitus ulcer; Discipline of Nursing; Disease Progression; Education; Effectiveness; Elderly; Environment; Evaluation; Event; Evidence based intervention; Family; Family Caregiver; Focus Groups; Fright; Goals; Healthcare Systems; Hospitalization; Hospitals; Hour; Individual; Intervention; Knowledge; Length of Stay; Long-Term Care; Maintenance; Maryland; Massachusetts; Measures; Medication Management; Mentors; Methods; Modeling; Nurses; Nursing Homes; Nursing Research; Outcome; Pain; Pennsylvania; Physical activity; Policies; Preparation; Process; Quality of life; Randomized; Randomized Controlled Trials; Research; Resources; Services; Testing; Time; Training; Translations; Treatment Efficacy; Work; base; caregiving; cost; dissemination trial; effective intervention; efficacy trial; evidence base; experience; fall risk; falls; functional decline; implementation trial; improved; improved functioning; instrumental activity of daily living; multiple chronic conditions; prevent; public health relevance; sedentary; social; social cognitive theory; theories; volunteer

 DESCRIPTION (provided by applicant): Assisted living (AL) settings provide homelike environments for individuals who need help with activities of daily living (ADL) or instrumental ADLs (e.g., medication management) but for whom 24-hour nursing care is not necessary. Nearly 40% of residents in AL settings require assistance with three or more ADLs and most need help with meal preparation and medication management. They tend to experience even more functional decline and spend less time in physical activity than residents in nursing facilities. This decline is not completely related to disease progression. Rather, it is due to the way care is provided and the tendency caregivers have to perform the care task for the resident rather than allowing him or her to do the activity. In addition, there is an excessive fear among older adults, families and caregivers that engaging in physical activity will result in adverse events (e.g., falls). The persistent decrease in function and physical activity in residents actualy increases their risk for falls, pain, pressure ulcers, further functional decline, hospitalizations nursing home placement, and decreases quality of life. Function Focused Care for AL (FFC-AL) is an approach to care such that residents are helped to participate in functional and physical activity throughout the course of the day. FFC-AL is a four-step theory-based approach including: (1) Environment and Policy Assessments; (2) Education; (3) Establishing Resident Service Plans; and (4) Mentoring and Motivating Direct Care Workers and Residents. In efficacy trials, FFC-AL was implemented over 12 months by a Research Nurse Facilitator working with an identified setting champion. Residents in settings exposed to FFC-AL maintained or improved function, spent more time in physical activity and were less likely to be transferred to acute care facilities. Unfortunately, implementing effective care approaches like FFC-AL into AL settings is challenging due to setting and resident related factors. To overcome these challenges we developed a theory based approach using Social Cognitive Theory, the Social Ecological Model and the Evidence Integration Triangle (EIT). This approach, referred to as FFC-AL-EIT, includes the involvement of setting stakeholders, uses resources currently available in AL settings and allows for an individualized focus on setting specific challenges. This study will test the dissemination and implementation of FFC-AL-EIT across 96 AL settings in Maryland, Pennsylvania and Massachusetts and will include 960 residents. The Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) model will be used to evaluate outcomes. By using a theory based approach and building off prior experience in disseminating and implementing function focused care, this study will add to what is known about dissemination and implementation of effective interventions in AL settings and serve as a model for other care approaches.

 描述（由适用提供）：辅助生活（AL）设置为需要在日常生活（ADL）或工具ADL的活动（例如，药物管理）的个人提供帮助的个人，但不需要24小时护理。在AL环境中，近40％的居民需要在三个或更多ADL的情况下提供帮助，并且大多数需要在准备和药物管理方面提供帮助。与护士设施中的居民相比，他们倾向于经历更多的功能下降，在体育活动上花费更少的时间。这种下降与疾病进展并不完全有关。相反，这是由于 提供方式护理，趋势护理人员必须为居民执行护理任务，而不是允许他或她进行活动。此外，老年人，家庭和看护人对从事体育锻炼的恐惧会导致不良事件（例如瀑布）。居民的功能和体育锻炼的持续下降实际上增加了跌倒，疼痛，压力溃疡，进一步的功能下降，住院护理家庭安置以及发展生活质量的风险。针对AL功能的护理（FFC-AL）是一种护理方法，使居民在整个一天的过程中有助于参与功能和体育锻炼。 FFC-AL是一种基于四步理论的方法，包括：（1）环境和政策评估； （2）教育； （3）建立居民服务计划； （4）指导和激励直接护理人员和居民。在有效的试验中，FFC-AL在12个月的时间内由研究护士的协助者与已确定的环境冠军一起实施。暴露于FFC-AL的设置中的居民维持或改善了功能，花了更多的时间进行体育锻炼，并且不太可能被转移到急性护理设施上。不幸的是，由于设置和居民相关的因素，将FFC-AL等有效护理方法纳入AL设置很具有挑战性。为了克服这些挑战，我们使用社会认知理论，社会生态模型和证据整合三角（EIT）开发了一种基于理论的方法。这种方法（称为FFC-AL-EIT）包括设置利益相关者的参与，使用当前在AL设置中可用的资源，并允许个性化的重点在设置特定挑战上。这项研究将在马里兰州，宾夕法尼亚州和马萨诸塞州的96个AL环境中测试FFC-AL-EIT的传播和实施，并将包括960名居民。覆盖率，有效性，采用，实施和维护（RE-AIM）模型将用于评估结果。通过使用基于理论的方法并建立了以前的专注于关注功能的先前经验，这项研究将增加有关在AL环境中有效干预措施的传播和实施的知识，并作为其他护理方法的模型。